Imagine you’re living your life and everything seems normal. Then all of a sudden, you start hearing and seeing things nobody else does. This is the reality for people living with psychosis – a mental condition that makes you believe things that aren’t real.

Ordinarily, commonsense tells us these over-the-top thoughts are irrational, but for someone experiencing a psychotic episode, it can be very difficult to tell what’s real from what isn’t. So what causes it?

While there are many theories about what triggers the condition, there are no definite answers. It often occurs as part of other mental illnesses and features three key symptoms: voice hearing, hallucinations and paranoia.

A popular misconception about psychosis is that it’s solely caused by genetics, but according to researchers in the documentary Why Did I Go Mad?, that’s not the only risk factor.

To gain a better understanding of the condition, let’s take a look at some of the most common myths and misunderstandings to help separate fact from fiction.

Fiction: It won’t happen to me

Like millions of others, Dr David Strange never thought he was at risk.

One of the biggest misconceptions about mental health is that you’re either well or unwell, but as psychologist Clare Mann explains, we all have the potential to experience some kind of psychotic episode. “It’s a question of mental wellness rather than illness,” she says.

According to SANE Australia, one in every 200 adult Australians will experience some kind of psychotic episode in any 12-month period, but the reasons why can vary from person to person and even between one episode and another.

Mann says mental health is best described as a continuum, which ranges between mentally well and mentally unwell. And at any given moment, your health can fluctuate from being very well and in control to periods of being very unwell and stressed.

“Everyone will experience sadness from time to time, and perhaps become depressed, but we’re not necessarily mentally ill,” she says. “It’s only when your health falls outside of the healthy range – such as a during a disturbing experience – that your risk of psychosis increases.”

Fact: Psychosis starts in childhood

Jacqui Dillon opens up about her childhood trauma.

Although people often think of psychosis as appearing “out of the blue”, Mann says there’s a definite relationship between early life trauma and high-risk factors in developing both post-traumatic stress disorder (PTSD) and psychosis.

“Psychosis is a break from reality. So if a child has experienced a traumatic event or longer-term trauma, they may avoid the potential threat by escaping to a different reality using dissociation – the act of separating mind from physical experience – increasing the risk of future psychosis,” she says.

A study published by The British Psychological Society found that adults who experienced trauma in early childhood were 10 times more likely to experience a psychotic episode later in life.

In the documentary, Jacqui Dillon opens up about her painful childhood memories. “I think the reason I began hearing voices when I was so little was because of the abuse and trauma I experienced,” she recalls. “My mind literally fragmented as a consequence of things that happened to me.”

Fact: Some people are more at risk

Professor Swaran Singh discusses social marginalisation.

While genetics, early childhood trauma, mental disorders and drug use all increase your chances of developing psychosis, experts in the documentary say one of the biggest indicators of poor mental health is social marginalisation, especially for immigrant refugees.

Mann says unlike non-refugee immigrants, who come to Australia to start a new life, refugees are fleeing from something. “Not only are they experiencing fear and wanting asylum, but they may then come into a world that’s prejudiced against them.”

As a result, some refugees experience social isolation – increasing the risk of poor mental health as a result of being an outsider. “It can be terribly traumatic for them. They may then become depressed, paranoid or delusional because they don’t feel anchored in the world,” she says.

Fiction: Medication is the only treatment

Rachel Waddingham puts a face to her voices using avatar technology.

Another common myth about psychosis is that you can’t get well again, but as Mann explains, the vast majority of those affected live ordinary lives, managing their symptoms daily. But this wasn’t always the case.

During the medieval era, patients were imprisoned in dungeons. And later in the Victorian age, electric shock treatment and brain surgery were both common and controversial – until the first generation of antipsychotic medications were discovered in the 1950s.

“These archaic practices resulted in a total loss of thinking ability, cognition skills and self-awareness. There was also a religious component to mental illness, so many assumed people were possessed by evil spirits – all based on ignorance,” Mann explains. “While these early methods left a lot to be desired, nowadays we have more compassion for people.”

Treatments include cognitive behavioural therapy (CBT), psychoeducation and family therapy, as well as more experimental techniques such as avatar therapy, which basically puts a face to auditory hallucinations.

If you or someone you know is experiencing mental health issues, contact your GP. For a list of health professionals with expertise in treating these issues, visit beyondblue.com.au or call 1300 224 636. For immediate help, call Lifeline on 131 114.

This piece by Mark Brook was originally seen on ‘SBS News‘, 13 March 2018.